Chinese Journal of Blood Purification

12 June 2020, Volume 19 Issue 06 Previous Issue    Next Issue

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The burden of renal anemia 2020, 19 (06):  361-363.  doi: 10.3969/j.issn.1671-4091.2020.06.001 Abstract ( 414 )   PDF (338KB) ( 843 )   【Abstract】Anemia is a common complication among chronic kidney disease patients, which affects health and quality of life of the patients, and imposes a tremendous economic burden for patients and society. Currently, the compliance rate of renal anemia is unsatisfactory. Accurate evaluation of the target of renal anemia treatment, rational and effective use of anti-anemia drugs, and development of economical and effective new anti-anemia drugs are essential in clinical practice. Treatment of renal anemia can be of great significance to reduce the burden of patients and society, improve the quality of life in CKD patients, delay the disease progression, and improve the clinical prognosis. Metrics

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Cardiovascular safety in CKD patients with anemia 2020, 19 (06):  364-367.  doi: 10.3969/j.issn.1671-4091.2020.06.002 Abstract ( 347 )   PDF (438KB) ( 842 )   【Abstract】Anemia is one of the most common complications in chronic kidney disease (CKD) patients. Cardiovascular disease is a major cause of mortality in CKD patients at stage 3～5. Renal anemia can aggravate the multisystem organ damages and is an important independent risk factor for cardiovascular complications in CKD patients. Therefore, management of renal anemia must be emphasized to improve the cardiovascular outcome in CKD patients. This article reviews cardiovascular safety in CKD patients with anemia from the view point of renal anemia and its treatment. Metrics

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Iron deficiency and iron metabolism in chronic kidney disease patients 2020, 19 (06):  368-371.  doi: 10.3969/j.issn.1671-4091.2020.06.003 Abstract ( 325 )   PDF (452KB) ( 847 )   【Abstract】Chronic kidney disease(CKD) patients are often accompanied by various degrees of iron deficiency and iron metabolism disorders; hepcidin, inflammation, erythropoietin and hypoxia-inducing factors are involved in the abnormalities. Iron deficiency can be classified into absolute iron deficiency and functional iron deficiency. Hepcidin, ferritin and transferrin saturation are useful markers to evaluate and diagnose iron deficiency. Clinically, rational use of iron supplements, reduction of hepcidin level, and improvement of iron metabolism are critical in the treatment of iron deficiency in CKD patients. Metrics

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Association between the TaqI polymorphism in vitamin D receptor gene and the prognosis of chronic kidney disease patients on dialysis 2020, 19 (06):  372-375.  doi: 10.3969/j.issn.1671-4091.2020.06.004 Abstract ( 320 )   PDF (479KB) ( 739 )   【Abstract】Objective To analyze the correlation between the TaqI polymorphism in vitamin D receptor gene and the prognosis of chronic kidney disease (CKD) patients on dialysis, in order to evaluate the gene polymorphism relating to the prognosis of the patients. Methods This was a casEcontrol study. Seventy-five CKD patients on dialysis admitted to Chengdu First People's Hospital from April 2015 to April 2016 were recruited as the observation group, and 70 healthy patients undergoing physical examination in Chengdu First People's Hospital were selected as the control group. PCR products were digested with the restriction enzyme and then separated in agarose gels to identify the TaqI polymorphism. Genotype of the TaqI polymorphism in vitamin D receptor gene, results of follow-up study and survival rate after one year were compared between the two groups. Clinical characteristics, survival rate and median survival time were also compared in patients with different genotypes of the polymorphism. Results In observation group, the genotype frequency of TaqI polymorphism in vitamin D receptor gene was TT genotype 34 cases, Tt genotype 23 cases, and tt genotype 18 cases, demonstrating that the frequency of tt genotype was lower in observation group than in control group (χ2=9.504, P=0.002) and the frequencies of TT genotype and Tt genotype were similar between the two groups (χ2=2.362 and 2.838 respectively, P=0.124 and 0.092 respectively). The total mutation rate was 76.00% in observation group, higher than that in control group (51.43%; χ2=29.504,P=0.002). There were no significant differences in sex, age, primary disease, low density lipoprotein,high density lipoprotein, triglyceride, urea nitrogen, serum creatinince, calcium, pbosphorus and 1,25 (OH)2D3 among the patients with TT genotype, Tt genotype and tt genotype (χ2= 0.308, P=0.857; F=0.272, P=0.762; χ2=3.682, P=0.720; F=0.027,P=0.973; F=0.136, P=0.824; F=0.053, P=0.948; F= 0.157, P=0.855; F=0.020, P=0.980; F=0.020, P=0.971; F=0.177, P=0.838; F=0.297, P=0.744). The results of follow-up study for one year showed that 56 of the 75 patients(74.67%) survived. The onEyear survival rate was 74.6% (56/75 survived). The onEyear survival rate and median survival time were statistically higher in patients with tt genotype than in those with Tt genotype and TT genotype(χ2=6.871, P=0.032; F=78.697, P＜0.001). Conclusion The genotype frequency of TaqI polymorphism in vitamin D receptor gene was different between CKD patients on dialysis and healthy people, and was closely related to the survival rate and survival time of the patients. The survival time was shorter in patients with mutation, which can be used for the prognostic prediction. Metrics

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The relationship between the serum levels of soluble growth stimulation expressed gene 2 (ST2) and tenascin-C (TN- C) and the cardiovascular events in maintenance hemodialysis patients 2020, 19 (06):  376-380.  doi: 10.3969/j.issn.1671-4091.2020.06.005 Abstract ( 283 )   PDF (455KB) ( 693 )   【Abstract】Objective To investigate the relationship between the serum levels of soluble growth stimulation expressed gene 2 (ST2) and tenascin-C (TN-C) and the cardiovascular events in maintenance hemodialysis (MHD) patients. Method This study enrolled 115 MHD patients admitted to the First Affiliated Hospital of Xinxiang Medical College from October 2016 to October 2019. According to the presence or absence of cardiovascular events, they were divided into two groups: cardiovascular event group (n=47) and non-cardiovascular event group (n=68). In addition, 58 healthy volunteers in the First Affiliated Hospital of Xinxiang Medical College were recruited as the control group. Clinical data of the patients were collected. Serum ST2 and TN-C levels of the patients and healthy controls were assayed by ELISA. Multivariate logistic regression was used to analyze the influencing factors for cardiovascular events in MHD patients. ROC curve was used to evaluate the predictive value of every index for cardiovascular events in MHD patients. Results Serum ST2 and TN-C levels were significantly higher in MHD group than in control group (t=30.357 and 42.237 respectively,P<0.001). Gender, primary disease, systolic blood pressure, total cholesterol, high-density lipoproteins, low-density lipoproteins, triacylglycerol, blood phosphorus, blood calcium, serum creatinine, left ventricular ejection fraction and left ventricular end diastolic diameter had no statistical significances between cardiovascular event group and non-cardiovascular event group (χ2=0.096，P=0.757; χ2=0.961, P=0.327; t=1.456，P=0.074; t=0.850, P=0.199; t=0.566, P=0.286; t=0.744, P=0.229; t=1.494, P=0.069; t=1.245, P=0.108; t=0.798, P=0.213; t=1.641, P= 0.052; t=0.695, P=0.244), but age (χ2=4.865, P=0.027), dialysis time(t=15.078,P＜0.001), C-reaction protein (t=9.285, P＜0.001), uric acid (t=17.549, P＜0.001), albumin (t=4.213, P＜0.001), ST2 (t=18.337, P＜0.001) and TN-C (t=16.585, P＜0.001) were significantly higher in cardiovascular event group than in non- cardiovascular event group. Multivariate logistic regression analysis showed that age (OR=2.235, 95% CI: 1.215～4.102, P=0.015), dialysis time (OR=4.251, 95% CI: 1.025～4.305, P=0.038), ST2 (OR=6.560, 95% CI: 1.059～2.300, P=0.024) and TN-C (OR=5.208, 95% CI: 1.043～1.397, P=0.013) were the independent risk factors for cardiovascular events in MHD patients. ROC curve showed that the AUC for predicting cardiovascular events using ST2 and TN-C levels were 0.813 and 0.786 respectively, the sensitivities were 78.62% and 76.30% respectively, and the specificities were 73.41% and 70.72% respectively. Conclusion Serum ST2 and TN-C levels increased significantly in MHD patients. Higher serum ST2 and TN-C levels were the influencing factors for cardiovascular events in MHD patients, and also had predictive value for cardiovascular events in MHD patients. Metrics

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Clinical observation on the effect of vertical pulse to improve dialysate drainage disorder due to catheter displacement 2020, 19 (06):  381-384.  doi: 10.3969/j.issn.1671-4091.2020.06.006 Abstract ( 218 )   PDF (488KB) ( 723 )   【Abstract】Objective To investigate the clinical effect of vertical rhythm on ameliorating dialysate drainage disorder due to catheter displacement in peritoneal dialysis (PD) patients. Methods A total of 22 PD patients treated in the Department of Nephrology, the First Affiliated Hospital of Shanghai Jiaotong University from May 2017 to May 2019 were recruited. These patients complied with the diagnosis of drainage barrier due to PD catheter displacement confirmed by stand abdominal X-ray plain film. We used the vertical rhythm instrument with high frequency and low amplitude vibration to treat the patients. Their 24-hour ultrafiltration volume before and after the treatment was recorded, PD fluid drainage speed was assessed, and the place of PD catheters was rEexamined by abdominal X-ray plain film. Results Among the 22 PD patients with catheter displacement, the average drainage rate of the outflow fluid increased by 59.317ml/min (80.284±26.079ml/min vs. 20.931± 7.366ml/min (t=10.656, P＜0.001) after vertical rhythm treatment. The place of PD catheters restored to the true pelvis in 3 cases; the tips of PD catheters moved down 1-2 vertebra levels in 17 cases and the drainage disorder remained in 2 cases. Conclusion The vertical rhythm therapy is simple to operate and can effectively improve the obstruction of dialysis fluid drainage caused by catheter displacement. This method is worthy of clinical use. Metrics

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Effect of obstructive sleep apnea on carbon dioxide binding capacity and left ventricular remodeling in patients with maintenance hemodialysis 2020, 19 (06):  385-388.  doi: 10.3969/j.issn.1671-4091.2020.06.007 Abstract ( 206 )   PDF (413KB) ( 664 )   【Abstract】Objective To explore the clinical characteristics of obstructive sleep apnea (OSA) in patients with maintenance hemodialysis (MHD). Methods Forty- two MHD patients were enrolled for night- time sleep breathing monitoring. They were divided into the OSA group (n=31) and the non-OSA group (n=11). The OSA group was further divided into a mild group (n=16) and a moderatEsevere group (n=15). The clinical characteristics between the four groups were compared. Results ①The incidence of left ventricular concentric hypertrophy was higher in OSA group than in non-OSA group (χ2=12.129, P=0.001). ②The daily sodium bicarbonate intake was higher in OSA group than in non-OSA group (t=-2.383, P=0.022), and was higher in moderatEsevere OSA group than in mild OSA group (t=- 2.448, P=0.021). Conclusion Clinicians should pay attention to the early diagnosis and prevention of OSA in MHD patients. Unlike the OSA in general population, serum CO2CP is negatively correlated with the degree of OSA in MHD patients, suggesting that clinicians should concern about the amount of sodium bicarbonate to correct acidosis. Metrics

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The application of automated peritoneal dialysis to inpatients requiring intensive dialysis therapy 2020, 19 (06):  389-392.  doi: 10.3969/j.issn.1671-4091.2020.06.008 Abstract ( 257 )   PDF (394KB) ( 667 )   【Abstract】Objective To investigate the effectiveness and complications of automated peritoneal dialysis (APD) in inpatients requiring intensive dialysis therapy. Methods A total of 28 patients undergoing intensive APD treatment in the Nephrology Department of Drum Tower Clinical College of Nanjing Medical University from January 2016 to December 2017 were included in this retrospective study. Patients were divided into intermittent peritoneal dialysis group (IPD; n=19) and tidal peritoneal dialysis group (TPD; n=9) according to the APD modality. Results There were 40 intensive dialysis indications in the 28 APD patients; volume overload (12 cases in IPD group and 5 cases in TPD group) was the most common indication for intensive dialysis in these patients, followed by hyperkalemia (5 cases in IPD group and 5 cases in TPD group), severe azotemia (4 cases in IPD group and 2 cases in TPD group), metabolic acidosis (3 cases in IPD group and one case in TPD group) and preoperative preparation (2 cases in IPD group and one case in TPD group). After APD treatment for 72 hours, body weight, type B natriuretic peptide, New York Heart Association (NYHA) heart function classification and serum potassium changed significantly (for IPD group: t=21.040, 20.069, 9.950 and 23.724 respectively, P＜0.001; for TPD group: t=7.785, 11.068, 6.832 and 10.424 respectively, P=0.001, ＜0.001, 0.003 and ＜0.001 respectively) in volume overload patients in both groups; gastrointestinal symptoms and mini nutritional assessment (MNA) score improved significantly (t=-27.000 and -16.202 respectively, P＜0.001) in patients with gastrointestinal symptoms (10 cases in IPD group and 7 cases in TPD group). No severe complications and no death of the patients occurred during the APD treatment. APD-related complications such as alerts of the cycler, perfusion/drainage pain, incision leakage; catheter dysfunction, hydrocele testis and hernia were not found. Conclusion APD can effectively and safely be used for intensive peritoneal dialysis patients who need to receive short-term and high dose dialysis treatment. Metrics

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Analysis of influencing factors of autogenous arteriovenous fistula dysfunction in maintenance hemodialysis patients#br# 2020, 19 (06):  393-397.  doi: 10.3969/j.issn.1671-4091.2020.06.009 Abstract ( 308 )   PDF (452KB) ( 955 )   【Abstract】Objective To investigate the correlation between G-395A polymorphism in klotho gene and autogenous arteriovenous fistula (AVF) dysfunction in maintenance hemodialysis (MHD) patients. Methods This prospective study included 198 MHD patients undergoing AVF surgery at Jiangsu Province Subei People's Hospital in the period from January 2015 to January 2018. The singlEnucleotide polymorphism at the G-395A in Klotho gene was identified by first generation sequencing. Serum klotho and FGF23 levels were measured by ELISA. Clinical and biochemical data were collected. Cox regression model was used to analyze the relevant factors affecting the life span of AVF. Results These MHD patients were followed up for 2 years, in which 5 lost the follow-up, and 3 died. The survival rates of AVF after one and two years were 88.9% and 77.8%, respectively. According to the presence or absence of A allele, the patients were divided into A allele carriers (GA genotype or AA genotype) and non-A carriers (GG genotype). The patency rate was lower in A allele carriers than in non-A carriers (χ2=9.062, P=0.003). Multivariate Cox proportional hazards model showed that genotype (HR=2.664, 95% CI: 1.594-～4.452, P<0.001), history of catheterization (HR=2.299, 95% CI:1.048～5.045, P=0.038) and FGF23 level (HR=1.002, 95% CI: 1.000～1.003, P=0.009) were the factors influencing long-term patency of AVF. Conclusion The G-395A polymorphism in klotho gene may relate to the long-term patency of autogenous AVF in MHD patients, and A allele may be an independent risk factor for AVF failure. Metrics

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Clinical value of color Doppler ultrasound examination for functional autogenous arteriovenous fistula with the target Kt/V value 2020, 19 (06):  398-402.  doi: 10.3969/j.issn.1671-4091.2020.06.010 Abstract ( 318 )   PDF (429KB) ( 838 )   【Abstract】Objective To study the value of color Doppler ultrasound examination to find out complications in functional autogenous arteriovenous fistula (AVF) with target Kt/V value, to analyze the relationship between color Doppler ultrasound parameters and pump-controlled blood flow, and to evaluate the impact of color Doppler ultrasound findings on clinical practice. Methods A total of 68 maintenance hemodialysis (MHD) patients were enrolled in this study. Their clinical and biochemical data and color Doppler ultrasound examination results were collected. The patients were then divided into fistula stenosis group and non-fistula stenosis group. Results ①Color Doppler ultrasound examination found the many complications, including stenosis (23/68 cases, 33.8%), aneurysm (10/68 cases, 14.7%), thrombosis (11/68 case, 16.2%), calcification (13/69 cases, 19.1%), vascular branches (23/68 cases, 33.8%), and distal radial artery reflux (17/59 cases, 28.8%). ② Compared with non-fistula stenosis group, fistula stenosis group had older age (t=2.559, P=0.013),more fistulas located at distal forearm (χ2=5.302,P=0.021), lower pump- controlled blood flow (t=- 2.710, P=0.009), smaller diameters of anastomosis orifice (t=-2.987, P=0.004) and brachial artery (t=-2.711, P=0.009), lower blood flow at the puncture site (t= -2.158, P= 0.035), and reduced blood flow in brachial artery (t=-2.657, P=0.010). Pearson correlation analysis showed that pump- controlled blood flow was positively correlated with the diameters of anastomosis orifice (r=0.452, P＜0.001), puncture site (r=0.441, P＜0.001), radial artery (r=0.469, P＜0.001) and brachial artery (r=0.445, P＜0.001), and blood flow volumes at the puncture site (r=0.369, P=0.002) and in brachial artery (r=0.384, P=0.001). ③Based on the results of color Doppler ultrasound examinations, percutaneous angioplasty was performed in 5 cases, surgical reconstruction in one case, and rEadjustment of the puncture site in 20 cases. Repeated color Doppler ultrasound examinations were required every 1- 3 months in 30 cases. Conclusion Color Doppler ultrasound examinations found higher rates of complications in functional AVFs with target Kt/V value. Color Doppler ultrasound parameters were closely related to the blood flow in AVFs, indicating that color Doppler ultrasound examination is useful for monitor of AVF functions and management of AVFs in clinical practice. Metrics

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Research progress in new peritoneal dialysis fluid 2020, 19 (06):  403-405.  doi: 10.3969/j.issn.1671-4091.2020.06.011 Abstract ( 448 )   PDF (365KB) ( 956 )   【Abstract】 Peritoneal dialysis (PD) fluid is an indispensable part of PD. New PD dialysate is required to have better dialysis function, biocompatibility and protection of peritoneal function to improve quality of life and prognosis of PD patients. This paper summarizes the research progress in new peritoneal dialysis fluid. Metrics

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Research progress in the influencing factors for phosphorus clearance in peritoneal dialysis patients 2020, 19 (06):  406-409.  doi: 10.3969/j.issn.1671-4091.2020.06.012 Abstract ( 261 )   PDF (361KB) ( 792 )   【Abstract】Hyperphosphatemia is a common complication of chronic kidney diseases and is also important predictors of cardiovascular disease and all- cause mortality in peritoneal dialysis (PD) patients. Hyperphosphatemia is common in PD patients and seriously affects their quality of life and prognosis. Clinically, the complicated management of serum phosphorus involves diet, phosphorus binding agents, residual kidney function and PD. However, the factors affecting phosphorus clearance in PD patients are still controversial. This article reviews the research progress about the influencing factors on phosphorus clearance in PD patients, hoping to make a better comprehension of this issue and to find key points for intervention. Metrics

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2020, 19 (06):  410-412.  doi: 10.3969/j.issn.1671-4091.2020.06.013 Abstract ( 199 )   PDF (265KB) ( 728 )   Metrics

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A study on improving the compliance rate of plasma phosphorus based on data feedback from Wuhan Hemodialysis Quality Control Platform 2020, 19 (06):  416-419.  doi: 10.3969/j.issn.1671-4091.2020.06.015 Abstract ( 218 )   PDF (473KB) ( 665 )   【Abstract】Objective To improve the overall serum phosphorus (P) compliance rate in Wuhan based on the data feedback from Wuhan Hemodialysis Quality Control Center platform. Methods A total of 3,794 hemodialysis patients from 44 hemodialysis centers in Wuhan in the period from January 2018 to January 2019 were selected as the research subjects. The data feedback from Wuhan Hemodialysis Quality Control Center platform were used to calculate the serum P examination and compliance rates. After repeated evaluations and renovations for one year, serum P examination and compliance rates were rEcalculated and compared with the previous rates. Results ① Serum P and parathyroid hormone (PTH) levels decreased (F=11.976 and 10.414 respectively; P<0.001 and =0.015 respectively), and serum calcium (Ca) increased (c2=119.725, P<0.001). ②The rates of serum P, Ca and PTH examinations improved and increased constantly (c2=65.994, 80.834 and 182.306 respectively, P< 0.001). ③The compliance rates of serum P and Ca increased (c2=32.511 and 10.215 respectively, P<0.001 and =0.017 respectively), but the compliance rate of PTH remained unchanged (c2=0.764, P=0.858). Conclusion Based on the data feedback from this platform and continuous quality improvement, serum P level effectively reduced and serum P examination and compliance rates increased. Metrics

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The influence of building a continuous health education model based on patients' empathy on improving the negative emotion and quality of life in hemodialysis patients 2020, 19 (06):  420-423.  doi: 10.3969/j.issn.1671-4091.2020.06.016 Abstract ( 244 )   PDF (470KB) ( 676 )   【Abstract】Objective To explore the influence of building a continuous health education model based on patients' empathy on the negative emotion and quality of life in maintenance hemodialysis (MHD) patients. Methods During the period from June 2018 to June 2019, 80 outpatients on hemodialysis were randomly divided into experimental group (n=40) and control group (n=40). Conventional health education model was adopted for control group, and a continuous health education model based on patients' empathy in addition to the conventional health education model were used for experimental group. After the intervention for 3 months, the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess the anxiety and depression, and the MOS item short form health survey (SF-36) was used to assess the quality of life of the patients. Results After the intervention for 3 months, the SAS and SDS scores were significantly improved in experimental group as compared with those in control group (t=4.747 and 5.731 respectively; P<0.001). The scores of body function, body role, extremity pain, psychological hygiene, activity, social function, emotional role and overall health in SF-36 were significantly increased as compared with those in control group (t=14.810, 5.487, 5.512, 5.706, 15.880, 9.100, 3.885 and 3.496 respectively; P<0.001). Conclusion The continuous health education model of patients' empathy can effectively alleviate the occurrence and development of negative emotion in MHD patients, and improve their quality of life. This method is worthy of clinical use. Metrics

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The effect of nutritional assessment and special dietary guidance during dialysis nursing on hemodialysis patients 2020, 19 (06):  424-426.  doi: 10.3969/j.issn.1671-4091.2020.06.017 Abstract ( 278 )   PDF (409KB) ( 797 )   【Abstract】Objective The purpose of this article was to analyze the effect of nutritional assessment and integrated dietary guidance during dialysis nursing on hemodialysis patients. Methods A total of 131 hemodialysis patients treated in the Department of Nephrology, Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine during the period from November 20, 2017 to November 15, 2019 were enrolled in this study. They were randomly divided into control group (n=67), in which patients were treated with conventional nursing method, and study group (n=64), in which patients were treated with nutrition assessment and integrated dietary guidance in addition to the conventional nursing method. After the intervention for 3 months, malnutrition-inflammation score (MIS score), health status questionnaire (SF-36) score and dietary instruction satisfaction were compared between the two groups. Results After the intervention for 3 months, MIS and SF-36 scores were better in study group than in control group (t=27.729, P＜0.001). The overall scores of body, consciousness, and quality of life were higher in study group than in control group (t=18.198, 27.861 and 16.603 respectively; P＜0.001). The satisfaction degree was also higher in study group than in control group (t=8.092, P=0.004). Conclusion The nutrition assessment and special disease dietary guidance during dialysis nursing can improve nutritional status and quality of life in hemodialysis patients. Metrics

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Investigation on health literacy of infectious diseases in maintenance hemodialysis patients and analysis of its influencing factors 2020, 19 (06):  427-430.  doi: 10.3969/j.issn.1671-4091.2020.06.018 Abstract ( 241 )   PDF (419KB) ( 683 )   【Abstract】Objective To investigate the health literacy of infectious diseases in maintenance hemodialysis (MHD) patients, and to explore its related factors. Methods A cross-sectional investigation using the Infectious DiseasESpecific Health Literacy (IDSHL) was performed in 200 MHD patients. Results The health literacy scores of infectious diseases were 19.71±7.29 in the MHD patients, lower than the scores in general population. Patients (185 case, 92.5%) required health certificates for catering business had a relatively higher awareness rate of the prevention knowledge of infectious diseases. Patients (36 cases, 18%) had poor knowledge about the treatment of hepatitis B, to which antibiotics are not required. The literacy level of patients (β = 0.416, P=0.011) and the understanding of infectious diseases by self- evaluation (β =- 1.256, P＜0.001) were the influencing factors for health literacy of infectious diseases. Conclusion In clinical practice, knowledge education and training should be strengthened for patients with low education level and poor knowledge about infectious diseases, so as to improve their health literacy of infectious diseases. Metrics